by: Dr. Tom Pousti



With massive weight loss, in a short period of time, patients are often left with a significant amount of excess skin. Because of the rapid weight loss, the patient’s skin doesn’t “bounce back” adequately, resulting in a multitude of problems including problems with moisture, skin break down, hygiene and body image problems (aesthetic concerns). This excess skin remains a reminder of the person’s past problem with obesity and limits the patient’s satisfaction with the weight loss he/she has achieved. Although patients are often very pleased with the improvement in their medical issues (such as diabetes and high blood pressure) achieved after weight loss, they are still not happy when they look in the mirror. Plastic surgical procedures after weight loss may help the patient achieve their goals and significantly improve their self-image. It is important to work with a plastic surgeon with extensive experience due to the fact that treatment of the post-bariatric surgery patient is unique in that the patient’s skin elasticity has been permanently decreased, potentially resulting in faster recurrence of some of the patient’s presenting complaints. Dr. Pousti has helped many patient’s in this situation.

As patients lose weight, their face and neck skin often show signs of weight loss often associated with aging. They may notice loose skin of the eyelids, lower face (jowl) or neck area. Face and neck lifting surgery help eliminate loose skin and the underlying muscle and fatty tissue. The re-suspension of the tissues helps rejuvenate the face and neck area.

Many patients complain of “empty, droopy, saggy” breasts after weight loss – in fact, patients often say that they were happier with their breasts before weight loss than after (just like some patients are happier with their breast during pregnancy than after). Most patients after massive weight loss, benefit from breast augmentation (saline or silicone gel breast implants) along with breast lifting (mastopexy) surgery. The mastopexy operation serves to raise the nipple-areola complexes higher on the chest wall (by removing redundant or loose skin) while the breast augmentation serves to increase fullness of the breasts especially along the superior pole of the breasts. Usually, after significant weight loss, both breast implants and breast lifting are required for optimal results.

Saline Implants

Saline implants have a silicone rubber shell that is inflated to the desired size with sterile saline. The implants are placed under the pectoralis muscle deflated and therefore, the incision used for this type of implant is minimal. These implants can be overfilled to achieve a more rounded appearance.

Saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants.

Silicone Implants

Silicone implants have a silicone rubber shell that is filled with a fixed amount of silicone gel. Most silicone gel-filled implants are not adjustable and therefore, the incision used to place the silicone gel implant is larger than the incision needed for saline implants. The silicone gel implant cannot be overfilled – it comes in an exact size that cannot be manipulated.

Silicone implants vary in shell surface (smooth/textured), shape, profile, volume, shell thickness, and number of shell lumens.

Some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more natural result.

As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery.

Plastic Surgery Societies Applaud the FDA’s Decision to Approve Silicone Breast Implants

For Immediate Release: November 17, 2006

Arlington Heights, Ill. (November 17, 2006) – The American Society for Aesthetic Plastic Surgery and The American Society of Plastic Surgeons, the two largest plastic surgery membership organizations, applaud the FDA’s decision today to approve (manufacturer’s) silicone breast implants and return these devices to the U.S. market. This decision comes 14 years after the FDA restricted access to the silicone implants because of safety concerns. “This is a great day for American women and the plastic surgeons who care for them,” said Roxanne Guy, MD, ASPS president. “Silicone breast implants have been scrutinized more than any medical device, and we applaud the FDA for making its well thought-out decision and allowing American women to make informed choices about their health care.”

Patients will also often complain of loose skin of the abdomen and/or back areas. The redundant folds of skin may be “depressing” to patients who have worked hard to drop their weight (and maintain it) only to be left with even looser skin. Unfortunately, like the issues described above, these areas of excess skin do not improve despite the most rigorous diet and exercise schedule. Ironically, the redundancy of skin may worsen despite patients’ best efforts. Abdominoplasty (tummy tuck) surgery serve to remove the excess skin of the abdomen while tightening up the abdominal wall muscles. This operation serves to improve the contour of the abdominal wall while the patient is standing, leaning over and sitting down. At the same time, the pubic area (which is often of concern to patients after weight loss) may be reduced and “lifted”. If the pubic area is not addressed during the abdominoplasty procedure, the patient often will be dissatisfied with the end result of surgery.

Often patients will complain of excess skin circumferentially at the level of the abdomen and lower back. Lower body lifting and belt lipectomy procedures serve to remove redundant skin of the abdomen and back circumferentially – this operation serves to improve the contour of the buttocks, hips, thighs and abdomen.

Weight loss can leave loose or “hanging” skin of the upper arm, between the elbow and shoulder. This area is addressed using the brachioplasty or arm lifting surgery. One of the keys of this operation is to plan the resulting scar to fall at the lower edge of the arm so that the scar is not visible from the front or back view. This operation may be extended to address the excess skin of the upper chest as well (upper body lift).

Patient often complain of extra skin of the thighs as well. This area can be treated using the thigh lifting techniques. A medial thigh lift will address the inner thighs while the lower body lift addresses the outer part of the thighs.

When considering any type of plastic surgery, choosing your surgeon is one the most important decisions a patient makes. An astute patient will evaluate the doctor’s credentials, training, specific board certification and experience. Before and after procedures, meeting with previous patients and reading patient testimonials may be useful. Connection with the plastic surgeon is critical to individualize each patient’s case. Safety is of primary concern and factors such as medical problems, age, exercise tolerance and length of surgery are some of the factors considered during the consultation. Care must be taken not to attempt too much surgery simultaneously as this may result in complications. During the office visits, the surgeon will get to know more about the patient’s health history as well as expectations and goals. Patients are educated regarding the procedure, post-operative care and especially potential limitations and/or possible risks and complications of any planned procedure.

Dr. Pousti is well qualified to assist patients after massive weight loss. He is board certified in General Surgery as well as Plastic Surgery and has been trained at some of the finest institutions in the United States. He has been in private practice for over 12 years and has had the privilege of helping thousands of patients reaching their goals after significant weight loss.


About The Author
Dr. Tom Pousti is a La Jolla / San Diego Cosmetic Plastic Surgeon specializing in Reconstructive and Cosmetic Plastic Surgery and is dedicated to restoring appearance, self-esteem, function, and quality of life to his patients. After 17 years of extensive medical and surgical training, Dr. Tom Pousti is double board certified in General Surgery as well as Plastic and Reconstructive Surgery.